Our whistleblower team announces that a Sarasota-area doctor has agreed to pay $1.95 million to resolve a client’s lawsuit alleging that the doctor and his clinic billed the government for unnecessary ultrasounds performed on Medicare patients.

Morgan & Morgan represented Kathleen Siwicki, a former employee of Dr. Arthur S. Portnow and his Apple Medical Group. Siwicki alleged that from August 2009 to August 2017, Portnow submitted fraudulent claims to Medicare in order to perform medically unnecessary carotid, lower-extremity arterial, abdominal aortic and renal and renal artery ultrasounds, in addition to unnecessary echocardiograms. The doctor and his clinic are also accused of falsifying patient records in order to justify the unnecessary procedures. All in all, Dr. Portnow and his practice are accused of receiving hundreds of thousands of dollars as a result of the illegal testing.

Whistleblower attorney James Young, senior investigator David Reign, a retired FBI special agent, and the team worked closely with their client to gather evidence and build a case to expose the alleged fraud scheme. AUSA Chris Tuite and the government’s nurse analyst Lori Bloom also worked tirelessly, going through medical records and chronologies to build and support this case.

“Ms. Siwicki was able to walk us through both the technical aspects of the medical procedures being performed and the fraudulent billing that was occurring,” Reign said. “She worked tirelessly to make sure the government fully understood the issues and fraud that was being committed. Without the efforts of people like Ms. Siwicki, the government would be at a huge disadvantage in resolving cases and returning money to our healthcare system.”

“Our client, Ms. Siwicki, is a certified cardiovascular technologist who loved her career,” Young said. “Immediately after being hired by the defendant, she witnessed suspicious and unusual practices. Without people like Ms. Siwicki who bravely step forward to report bad practices, these types of schemes would continue unchecked for years on end.”

Siwicki filed the lawsuit under the whistleblower provision of the False Claims Act, which allows private individuals to sue on behalf of the government over false and fraudulent claims and allows them to share in the recovered funds. The law also allows the federal government to intervene in a lawsuit and assume the case, which it did in this instance solely for purposes of settlement. The settlement with the federal government resolves the lawsuit’s claims.

“This case exposes the fundamental flaw in our healthcare reimbursement system — it relies on the trust and integrity of physicians to bill for necessary and appropriate services and no more,” Young said. “The government cannot watch or audit every physician.”

If you have witnessed fraud and would like to talk to someone about holding the fraudster accountable, contact us for a free, confidential case evaluation. Our experienced team of whistleblower attorneys is here to help.